4. What about age? There is no age limit. After puberty, anyone can get dental implants.

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1 Dental Implants 1. What are Osseointegrated implants? Osseointegrated implants are a new generation of dental implants in Rio de Janeiro, introduced in the 1960 s, they come in different shapes and sizes. Dental implants act as artificial titanium roots that are surgically installed in the edentulous maxilla (upper jaw), mandible (lower jaw) and more recently the zygomatic bone areas. Dental implants are connected to the prostheses to rehabilitate lost teeth. 2. What is the magic of titanium? There is no magic in titanium. It is a material used in orthopedics for decades. Simply stated, titanium does not corrode when inserted in the human body and has no immune rejection phenomena. 3. Can anybody get dental implants? In order to rehabilitate with dental implants in the center of Rio de Janeiro, the patient must have a bone condition that provides the proper height and thickness to allow the establishment of a dental implant, as well as oral health satisfactory so not to compromise the success of the treatment. Regarding age, the minimum is 18 years and there is no maximum, but the patient has to have a controlled systemic condition and health. 4. What about age? There is no age limit. After puberty, anyone can get dental implants. 5. What is immediate implant? In some cases, the loss of a tooth is necessary. When this happens, once the tooth is removed, the dentist can place an immediate implant into the region. There is no need to wait for the implant to heal. Perform the extraction immediately. It can produce very good results. This, however, is not always possible. In some cases if there were a bone infection, you would expect to extract the tooth and eliminate the infection. In some situations, there are very large and thick roots, where the socket is larger or wider than the implant itself, and their placement will be compromised by lack of primary fixation. That is, there will not be enough bone to hold this implant. The qualified professional will choose the best option. 6. What is an immediate denture? Immediate dentures are ready to wear on the same day as your tooth extractions and can be in the form of a partial or a complete denture. When the bone is hard and is resisting, a period of osseo integration will occur together with the placement of the tooth. The implant s strength will increase. This is because the bone that

2 supports it is strong, and will bear the force of mastication. Do not want to say that osseointegration has occurred. During this period the tooth is placed provisionally. It is advisable to retain this only for 90 days, so that the gums do not become mature and retractions occur. The choice is always professional. 7. Why do some patients need bone grafts? The need for bone grafts is frequent. They can be done in a previous surgery to the deployment and, in this case, the implants are placed after a period of 4 to 5 months for the bone to heal. When possible, the graft is performed during the same implant surgery. 8. What is bone grafting? Bone grafting is a surgical procedure by which new bone or a replacement material is placed into spaces between or around broken bone or damaged bone to aid in healing. Bone grafting is used to repair bone fractures that are extremely complex, pose a significant risk to the patient, or fail to heal properly. Bone graft is also used to help fusion between vertebrae, correct deformities, or provide structural support for fractures of the spine. In addition to fracture repair, bone graft is used to repair defects in bone caused by birth defects, traumatic injury, or surgery for bone cancer.. 9. Where is this bone? Is it taken from me? From where? Bone grafting can be removed from the patient or not. If the region needs to be thickened is small, one can draw a region near the region receiving the graft. If you need a little more bone, we can use bone from Hospital bone banks clinic or the Hospital Santa Casa de Misericordia. In these cases, the patients who receive this bone will have a more relaxed postoperative. 10. How will I know I'll need a bone graft? The only way to accurately know if you need bone grafts is a CT examination. In this test we see the exact amount of remaining bone in the region. It is necessary and appropriate. 11. The panoramic radiograph is not enough? No. The panoramic radiograph gives an overview of the situation. It does not give a 3D view. Besides it does not have the most accurate measurements. This radiograph is used only to gain insight over all losses and general positions of the teeth and their structures. 12. Do you need to perform any treatment before placing the implants? In some cases, yes. We should eliminate any pre-existing infections in the oral cavity; periodontal treatment to treat (gum) disease, or an extraction of teeth with pockets of infection and endodontic treatments (channels) can be performed prior to deployment. All these aspects are part of an initial planning done by professional that should be discussed openly with the patient before starting

3 treatment. 13. It really hurts to have implants? No. The best thing about this whole process is that there is no pain. Obviously this is a surgical procedure and edema (swelling) is expected, especially on the second postoperative day. The swelling is larger than the size of the surgery. Bone graft surgery usually causes more injury. However, there are specific medications to control postoperative inflammation, and antibiotics (drugs that fight infection) and analgesics, the surgeon may prescribe if necessary. 14. How long will the treatment take? It depends on each case. After placement, the implants remain undisturbed for a period ranging from 2 to 6 months for the occurrence of the biological phenomenon of osseointegration (Direct union of titanium to the bone), after which the implants are uncovered and a prosthetic dental implant is connected through a secondary part called "abutment" or pillar. In cases involving bone graft, the treatment is inevitably longer. In some specific cases, the prosthesis can be installed on the day of implantation surgery. 15. Is there a risk of rejection? No, the dental implants are usually never rejected. Titanium is the material used in orthopedics for decades. This metal does not corrode when inserted in the human body and has no immune rejection phenomena. The success of dental implants in the center of Rio de Janeiro depends on planning, atraumatic surgical techniques (avoiding overheating of the bone) and good hygiene by the patient. 16. Why do failures occur? Incorrect treatment recommendation. Inadequate surgical techniques. Biological and inherent factors of the patient. Poor care from the patient. 17. How long does a dental implant last? It can be stated that in approximately 95% of cases, dental implants are not lost within the first two years of use and can last for much of the patient's life, provided that there is careful oral hygiene and periodic visits and maintenance with the dentist. 18. Can mobility of dental implant? Yes it can. It's good to check why the tooth on the implant is soft. Generally, the implant prostheses are cemented and not bolted. Thus, the cement used may be temporary. The cement will need to be replaced with permanent cement.

4 19. How is the aesthetic result? As the prosthesis, the results improved greatly in recent years, but not yet perfect. One must remember that no matter how good the outcome, it is a prosthesis of natural teeth by artificial substitutes. 20. Can there be a change in planning during surgery? Yes, although a good plan is to minimize this possibility. This alternative should be identified before surgery. The surgeon is the only one to make the decision during surgery. 21. How should I take care of the implants after the treatment? There may be complications related to the implants? The dental implant surgical installation in the center of Rio de Janeiro use a medicine that will help the patient feel as comfortable as possible. The medicine will be adjusted for each case according to the type of surgery and the patient's medical history. In addition, the patient is adequately anesthetized and can even be consciously sedated by an anesthesiologist before the surgery. There are cases of deeper sedation, which is performed only in hospitals. Recovery is usually very good, but the professional will instruct the patient of what they can and can t do in order to have a successful post operative. 22. Is there a risk of contamination? Yes risks may occur due to poor surgical techniques. The cleaning of the surgical environment, the surgeon s hands and the equipment should be all be perfect. 23. Can I eat anything after prosthesis placement? Certain foods may fracture the natural teeth. A minimum amount of care is sufficient for the preservation of natural teeth and the implant supported denture. 24. When should dental implants not be done? Patients with inadequate oral hygiene habits. Patients with health problems that may compromise the surgical procedure. Children Adults suffering from bone diseases. Patients dependent on alcohol or drugs. 25. What about patients who do not have adequate amount of bone to receive implants? These patients undergo another surgical procedure called bone grafting which seeks to increase the height or thickness of the bone at the surgical site allowing the installation the implant. Bone regeneration occurs five months after the graft surgery.

5 26. The patient must remain toothless during the osseointegration? The patient is not toothless. He will receive a prosthesis that will prevent the implant rejection and assist with comfort. 27. How is the post-op? The postoperative is relaxed if the instructions of the dentist are followed. The painful process can be mitigated with a simple analgesic. 28. How long is the surgery? The surgery is quick. Usually for the installation of two implants takes forty to sixty minutes. Including the time spent in this preparation (asepsis, anesthesia and accommodation of the patient). In some cases, especially when bone grafts are performed, this time is extended. 29. What is the surgical risk? The risk is very low. The anesthesia is local, but patients who have general health problems should ask for a medical evaluation. 30. What is the maintenance? The implants require the same care that should be given to the natural teeth, cleaning; hygiene and care will allow a permanent dentition. 31. And the failures? Despite the great advance of science, it is difficult to achieve a 100% success. The literature points to 2.5% as the expected percentage of failures. 32. Why ask for scans? They are requested especially when handling large losses in excess. They allow more safety during surgery.